How the Struggle for Public Health in the Jim Crow South Reflected and Reinforced Systemic Racial Health Inequality

Area of Science:

• Public Health History
• Social Determinants of Health
• Health Equity Studies

Background:

• The COVID-19 pandemic exposed deep-seated health inequities and public resistance to disease containment in the U.S.
• Institutionalizing public health in the United States has been a long-standing challenge, particularly in the early 20th century American South.
• This region, historically the unhealthiest in the U.S., faced significant health disparities exacerbated by the Jim Crow regime.

Purpose of the Study:

• To compare the public health concerns and coalition-building strategies of two distinct early 20th-century campaigns in the American South.
• To analyze the nature of southern resistance to public health expansion under different approaches.
• To understand the historical roots of present-day public health inequities and the marginalization of Black community health efforts.

Main Methods:

• Utilized archival data sources to examine two early 20th-century public health campaigns: Black-led self-organized health services networks and the Rockefeller Sanitary Commission (RSC).
• Explored the public health concerns, coalition-building tactics, and community engagement strategies of each campaign.
• Investigated the forms and extent of resistance encountered by these public health initiatives in the American South.

Main Results:

• Black-led campaigns, including the Tuskegee Woman's Club and the Negro Organization Society, formed cross-racial coalitions to deliver services and address environmental health risks at the community level.
• The Rockefeller Sanitary Commission (RSC) established state-level public health agencies through a top-down philanthropic model, offering short-term dispensaries that did not challenge Jim Crow practices.
• Both approaches encountered persistent resistance from the Southern populace, underscoring the challenges in expanding public health infrastructure and services.

Conclusions:

• Historical public health campaigns in the American South, despite differing strategies, reveal enduring struggles against health inequities and resistance to public health interventions.
• The legacy of these early 20th-century efforts demonstrates how political-economic and ideological forces marginalized Black community health initiatives, contributing to current public health disparities.
• Understanding these historical dynamics is crucial for addressing contemporary challenges in achieving health equity and effective public health institutionalization.